Median Survival Of Untreated Patients Research Articles

Phase II study of hepatic artery infusion with 5-fluorouracil, adriamycin, and mitomycin C (FAM) in liver metastases from colorectal carcinoma.

The liver may be the predominant organ of involvement in more than 50% of patients with colorectal carcinoma who develop metastatic disease. Once colorectal carcinoma metastasizes to the liver, prognosis becomes ominous. Median survival for untreated patients can be expected to be about 6 months [8,13,17] and it has been stated that the length of survival depends on the extent of hepatic metastases even if bones, lungs, and liver are all involved [8]. Systemic 5-fluorouracil (5-FU) is of limited value, median survival being approximately 8 months [15]. Because hepatic metastases receive their main blood supply from the hepatic artery, one way of approach has been ligation of the hepatic artery. In nonrandomized studies a median survival of about 11 months has been reported with this technique [1, 10]. Another treatment modality has been the infusion of cytostatic drugs into the hepatic artery. 5-FU (F), 5-fluoro-deoxyuridine (FUdR), and mitomycin C (M) are extracted by the liver; hence intraarterial administration of these drugs allows for a greater concentration into the tumor-bearing organ with less systemic toxicity. It has also been shown that the systemic Adriamycin (A) level during hepatic artery infusion (HAI) is 25% lower than the corresponding systemic level with peripheral venous infusion, while hepatic venous anthracycline levels, which are one measure of intrahepatic drug concentration in the hepatic and tumor capillary bed, are consistently higher when the drug is given by the hepatic artery route [5]. Employing the FAM combination systemically a response rate of only 17% has been reported in measurable advanced colorectal carcinoma [7]. HAI with a combination of five drugs including FAM yielded a response rate of 56% in patients with liver metastases from colorectal carcinoma [2]. In a pilot feasibility study in our institution 34 patients with liver metastases from colorectal carcinoma were treated by HAI with FAM. Results in a smaller series of patients with a shorter follow-up have already been reported [16]. In this report results are summarized after a median follow-up of 28 months.

Prognosis of primary hepatocellular carcinoma.

Prognosis of 600 consecutive patients with hepatocellular carcinoma was analyzed in relation to treatment. They were divided into three stages based on four parameters of advanced disease: ascites, tumor greater than 50% of the two-dimensional size of the liver, serum albumin below 3 gm per dl, and serum bilirubin above 3 mg per dl. Stage I had none of these signs; Stage II one or two signs, and Stage III three or all signs. Of 600 patients, 98 had resection, 333 had nonsurgical treatment (158 treated by intraarterial chemotherapy, 94 systemic chemotherapy, 77 transcatheter embolization, and 4 others) and 169 no treatment. The median survival of untreated patients was only 1.6 months from diagnosis, and no untreated Stage III patient lived more than 3 months; there was a median survival of 0.7 month. Surgically treated patients lived significantly longer than nonsurgical patients of comparable stages; median survival was 19.6 months in the former and 2.8 months in the latter. Whereas Stage I patients did fairly well without treatment, chemotherapy significantly prolonged survival of patients of Stages II and III. These results suggest that early diagnosis and hepatic resection improve prognosis in patients with hepatocellular carcinoma in the areas where this cancer frequently emerges unicentrically. In view of the generally poor prognosis, liver transplantation is recommended when resection is not possible or indicated, and before extrahepatic metastasis occurs.

Squamous carcinoma of the head and neck: the untreated patient

One thousand, nine hundred and seventy-seven patients with squamous carcinoma of the head and neck are reviewed with particular reference to the patients not treated. The commonest reason for not treating the patients was that the tumour was too extensive (55%). A further 36% were too old or infirm to be considered fit for radical treatment, and 9% of patients refused treatment. Treated and untreated patients were compared for age, sex, site of the primary and TNM stage. The proportion of patients untreated varied according to site of the primary tumour, with 25% of pharangeal tumours being the highest proportional representation. Median survival for untreated patients was 88 days; survival time was significantly related to sex, T stage of primary tumour and patient's general condition.

Combination Chemotherapy With Intermittent l-3-Bis(2-Chloroethyl)l-Nitrosourea (BCNU), Cyclophosphamide, and Prednisone for Multiple Myeloma

In order to study the effectiveness of the drug combination BCNU, cyclophosphamide, and prednisone (BCP) in myeloma, the Southeastern Cancer Study Group entered 126 previously untreated and 33 previously treated patients in this study. Patients received cyclophosphamide, 400 mg/sq m, BCNU, 75 mg/sq m, and prednisone, 80 mg/sq m, for 7 days, every 4 wk, and were evaluated for response after 6 mo of therapy. Responding patients were continued on therapy and followed for evaluation of survival. Previously untreated patients were evaluated for good and poor risk status as well as clinical stage by calculation of tumor cell mass. These calculated values, as well as the individual components such as blood urea nitrogen (BUN), immunoglobulin (Ig) type, and hemoglobin (Hb), were evaluated for correlation with response and survival. The response rate was approximately 50% for all untreated patients regardless of cell mass or risk status. Toxicity was not excessive, and no case of acute leukemia was seen. Median survival for untreated patients was 27.8 mo; good risk patients, 44 mo; and poor risk, 12 mo. Though cell mass status did not correlate well with survival, individual factors of BUN, IgAλ, and IgGκ protein types had strong predictive value. Using these factors, a model for survival predication was created that had high predictive value in this group of patients. The study indicates that this treatment regimen is effective and could be used as an alternative to standard chemotherapy or in sequential combinations. Since it does not contain melphalan, it might be attractive if melphalan-contain-ing regimens prove to be particularly leuke-mogenic. The survival-predictive model may be useful in assessment of patient prognosis and will be further evaluated in subsequent group studies.